Cervical cancer is preventable

Cervical cancer is the second most common cancer among Indian women. Statistics show that every year there are about 96,922 new cases of cervical cancer, one woman is affected every eight minutes. The leading cause of cervical, anal, vaginal, vulvar and some oropharyngeal is Human Papillomavirus (HPV) in both men and women.

In India, less than 1% of women have been vaccinated against HPV, which needs to be done before the age of 16. This leaves more than 453 million women above the vaccination age and at risk of cervical cancer. Of these women, less than 5% have got themselves screened even once in their lifetime. This lack of screening means 85% of the women with cervical cancer in India get diagnosed in the late stages, compared to about 20% in the US and UK. This has led to cervical cancer being the second largest killer of women amongst cancers in India and contributing to 25% of the world’s cervical cancer deaths. However, countries like Australia, have demonstrated that national vaccination and screening programs are working towards the complete elimination of cervical cancer in the next 20 years. Similar programs in the US have pushed the 5-year survival rate for cervical cancer, due to early detection through regular screening, to 92%. The bottom line is that cervical cancer is preventable and unnecessary deaths can be avoided. With timely prevention programs such as the human papillomavirus (HPV) vaccine and making cervical screening more accessible, cervical cancer could also be eliminated as a public health concern in India.

The World Health Organization (WHO) has also recognized the graveness and proposed targets for key interventions to be met by 2030. According to WHO, 90% of girls should be fully vaccinated by the age of 15 years; 70% of women screened with a high-precision test at 35 and 45 years of age; 90% of women identified with cervical disease receiving treatment and care.

The DNA based HPV test identifies women who could have cervical abnormalities in the future and can better differentiate between the less and more deadly strains of HPV. The only roadblock, therefore, to make the HPV test the test of choice, is to make it more affordable so that women in India get the same quality of care as the more developed markets.

Factors that impact low screening are the lack of awareness amongst women and even doctors, the awkwardness associated with getting a cervical sample by someone else, and lastly, the price of the test. Less than 7.5% of healthcare professionals get themselves screened; the use of self-collected samples is on the rise, and the price of the DNA based test is continually dropping. Cervical cancer in India requires attention at the grass-root level and there are very promising studies that are showing the way. The Barshi project which was carried out in India by several stakeholders deployed 4 different methods and allowed more than 400,000 women to be screened.

This has provided a ray of hope and there is no dearth of data as far as cervical cancer and prevention are concerned. However, governments typically get involved once there is a proven model at a reasonable level that can be templatized and replicated. Therefore the need of the hour is to demonstrate a successful screening program at a city or district level and then provide that data and the learnings from it to motivate the government organizations to step in and scale it further. With that in mind, I-SHARE is working with a number of NGOs, such as Prayas, private companies, such as GenePath Diagnostics Inc. and CSR funds, such as Gharda Chemicals, to reduce the number of deaths in the city of Pune due to cervical cancer by at least 70% by 2040. Started in July 2019, this program has already screened more than three thousand women and seen about 7% of the women testing positive that have been provided medical intervention to eliminate the chances of their infection becoming cancerous. The program has deployed a DNA based HPV test and offered it for free to these women. For this to achieve the scale needed to make an impact in Pune, with a population of seven million people, is going to require a lot of entities to collaborate closely. Only efforts such as this one will provide the government the motivation and approach needed to create a national cervical cancer screening program.
(The writer is the Chief Executive Officer of GenePath)